Hospitals are rescheduling elective surgeries but worry about demand after the backlog is cleared

For Ochsner Health System, getting hospital staff back online to resume elective surgical and diagnostic procedures has been the easy part of reopening for non-Covid care. The challenge for the Louisiana hospital system has been getting patients to feel comfortable about coming back.

“We knew several weeks ago that safety was going to be the priority for folks as they think about coming back and seeking any healthcare services, so we started thinking about how we approach that differently,” explained Warner Thomas, Ochsner’s CEO.

Now, patients and visitors who walk through the door will undergo a temperature scan, answer questions about coronavirus symptoms, and be given a mask if they don’t have one. Inside, they find waiting area chairs spaced for social distancing, receptionists behind safety partitions, and enhanced cleaning between appointments.

“We’ve gotten very positive feedback,” Thomas said. Patients “appreciate the extra precautions we’re taking, and I think because of that we’re seeing more folks than we anticipated coming back sooner for their medical care.”

This week Ochsner’s outpatient and surgical procedures have bounced back to between 55% and 60% of what they were during the same time last year. They had plummeted to just 20% of normal volumes between March and April, when hospitals were required to cancel non-emergency procedures due to the coronavirus outbreak.

Demand to reschedule procedures

As states have lifted the pandemic shutdown of non-emergency procedures, hospital systems across the country are now seeing a similar rebound in demand as patients look to reschedule procedures that were canceled. During the first week of May, half of hospital administrators surveyed by health care consulting firm LEK said they’d resumed procedures at lowered volumes. By the of end of last week, more than 70% said they’d reopened for elective care at reduced volumes.

“We’re seeing inpatient orthopedics, cardiovascular and oncology — the three big surgeries that have the greatest level of acuity associated with them — they are working through their backlog,” said Christopher Kerns, vice president at health care consulting firm Advisory Board, but he adds the outlook for new surgeries looks more uncertain.

“What health system leaders are telling us is that they’re feeling good about right now [but] they’re concerned about 60 days from now,” Kerns said.

Uncertainty beyond the backlog

Scheduling for new elective procedures usually happens about a month or two ahead of time. Executives are worried that the pipeline for new surgical referrals may not bounce back as quickly as rescheduled procedures, in part because some patients may continue to put off care due to fear.

Another concern is that specialist practices, which refer patients for diagnostic screening and surgery, are themselves reopening with lower patient volumes. An analysis by the Commonwealth Foundation found that patient visits at surgical and orthopedic practices have recovered this month, but are down more than 30% from normal volumes.

Like hospitals, physician practices and diagnostic screening facilities now have to take extra safety precautions which could mean that they won’t be able to see the same volume of patients for surgical consultations as they did before the pandemic.

Delays increase other risks

“We’re going to have to treat every patient — until there’s a vaccination — like they’re a potential Covid patient … Scheduling is going to have to be done very carefully for spacing between procedures and imaging,” said Charles Kahn, CEO of the Federation of American Hospitals.

The new safety measures may be giving patients a greater sense of security. More than 8 out of 10 Americans say they plan to resume medical appointments in person over next three months, according to the Kaiser Family Foundation health tracking poll for May.

Ochsner Health is reaching out to coax those patients to come in sooner, rather than later. During the last two months, New Orleans was one of the nation’s hot-spots for Covid infections, in part because so many patients have underlying chronic conditions which made them more vulnerable to the virus.

“What we’re seeing is people are delaying medical care and coming in with a worse situation,” said Thomas. “I would just encourage people to check out their medical facility and ask them what precautions they’re taking, but don’t delay medical care.”

The on-going challenge for physicians and hospitals amid coronavirus will be to convince patients that, not only is it safe to come back for treatment, but that putting off care carries its own health risks.